Provider First Line Business Practice Location Address:
6260 LAUREL CANYON BLVD
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91606-3258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-508-8112
Provider Business Practice Location Address Fax Number:
818-508-8097
Provider Enumeration Date:
07/14/2011